Background
Intentional self-harm, encompassing non-lethal incidents and suicide, remains a critical public health challenge globally and within Spain. Monitoring trends in these behaviors is essential to designing effective prevention strategies and mental health interventions. Non-lethal intentional self-harm (NLISH) often precedes or indicates suicide risk but differs in demographic and clinical profiles. Recent societal stressors, including the COVID-19 pandemic, may have influenced these patterns, making updated, nationwide data imperative.
Study Design
This comprehensive nationwide population-based registry study analyzed all hospitalizations due to NLISH alongside recorded suicides in Spain from 2018 through 2023. NLISH data were sourced from health registries capturing hospitalization events, while suicide data were obtained from national mortality records. The investigated parameters included sociodemographic variables (age, sex), clinical characteristics in hospitalizations, and methods employed for both NLISH and suicide events.
Annual and monthly trends were assessed using Joinpoint regression analyses to quantify changes in rates overall and specifically by sex and age strata. This statistical approach permits the identification of points where trends significantly change in magnitude or direction.
Key Findings
Over the study period, a total of 73,692 hospitalizations for NLISH and 23,496 suicides were recorded, averaging 12,282 and 3,916 cases annually, respectively.
Demographic Characteristics:
– NLISH hospitalizations were predominantly female (60.1%, n=44,304).
– Suicides were more common among males (74.4%, n=17,471).
– Youth aged 10–24 years constituted 24.3% (n=17,915) of NLISH hospitalizations but only 4.8% (n=1,125) of suicides.
– Older adults aged 65 and above accounted for 31.2% (n=7,327) of suicides but a smaller proportion of NLISH hospitalizations (12.8%, n=9,410).
Methods Used:
– Drug poisoning was the leading method in NLISH cases (68.7%, n=50,643).
– Hanging was the most frequent method in suicides (46.0%, n=10,810).
Trend Analysis:
– NLISH rates increased by an average of 8.0% per year (95% Confidence Interval [CI]: 1.5% to 15.9%), with a marked rise in young women following the 2020 onset of the COVID-19 pandemic.
– Suicide rates increased more modestly at 2.6% annually (95% CI: 0.6% to 4.8%), but significant rises were noted among young women and middle-aged men.
Expert Commentary
The differential patterns in NLISH and suicide highlight the complex nature of suicidal behaviors and the necessity of targeted preventive interventions. The disproportionately higher rate of NLISH in young females may reflect emerging psychosocial stressors, including pandemic-related isolation, economic instability, and mental health service disruptions.
Conversely, the elevated suicide rates in older adults, predominantly males using highly lethal means such as hanging, suggest the need for focused strategies addressing late-life depression, social isolation, and access to means restriction.
The study’s strengths include comprehensive population coverage and the use of robust statistical trend analyses. However, limitations include reliance on hospitalization data for NLISH, potentially underestimating community or less severe cases, and mortality record accuracy depending on death certification practices.
Conclusion
This nationwide study reveals an alarming increase in non-lethal self-harm and a smaller, yet significant, rise in suicide rates in Spain from 2018 to 2023. The findings particularly emphasize young women’s vulnerability to self-harm, alongside notable suicide increases in both young females and middle-aged males.
Urgent development and implementation of age- and gender-sensitive prevention programs are critical. Efforts should include improving mental health service accessibility, early identification and intervention for at-risk groups, public education to reduce stigma, and means restriction policies to curb suicide deaths.
Further research is warranted to unpack the underlying psychosocial and structural drivers, evaluate intervention efficacy, and monitor ongoing trends beyond 2023.
Funding
This study was supported by the Instituto de Salud Carlos III (ISCIII) through grants PI23CIII/00056, CP21/00078, AC22/00006, PI22/00107, and PI17/00521; the European Union NextGenerationEU/MRR; ERA PerMed; FMTV3 (202220-30); the American Foundation for Suicide Prevention (AFSP ECR-1-101-23); the Brain & Behavior Research Foundation (BBRF NARSAD-31312); and the National Institute of Mental Health (NIMH 1R25MH129256-01A1).
Reference
López-Cuadrado T, Mortier P, Alonso J, Martínez-Alés G. Trends of non-lethal intentional self-harm and suicide in Spain 2018-2023: a nationwide registry-based study. Lancet Reg Health Eur. 2025 Sep 27;58:101467. doi: 10.1016/j.lanepe.2025.101467. PMID: 41080066; PMCID: PMC12510044.
